Proposed 2011 Payment Rates from CMS Seeks Changes to the Hospital Outpatient Quality Data Reporting Program
On July 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released the FY 2011 Outpatient Prospective Payment System (OPPS) proposed rule. In addition to addressing significant payment issues, this proposed rule also seeks to promote higher quality, efficient services for Medicare beneficiaries by adopting improvements to the Hospital Outpatient Quality Data Reporting Program (HOP QDRP), which makes data about the quality of outpatient hospital services publicly available.
In the rule, CMS proposes expanding the quality measures for CY 2012, CY 2013 and CY 2014 payment determinations by adding new measures; and harmonizing the measures used in the HOP QDRP program with other CMS quality programs.
The Heart Rhythm Society will continue to analyze the proposed changes to the HOP QDRP and submit public comments by the August 31, 2010 due date. When making public comments on HOP QDRP, the Heart Rhythm Society will encourage CMS to utilize consistent policies and measures across all reporting and quality improvement programs as much as feasible.
CMS proposes the inclusion of the measure, "Counseling regarding Implantable Cardioverter-defibrillator (ICD) implantation for patients with Left Ventricular Systolic Dysfunction on combination medical therapy" for payment determination in 2013. This measure, and 11 other heart failure performance measures proposed for FY 2013, were developed, updated and reviewed by the American Medical Association's Physician Consortium for Performance Improvement (PCPI). Kathleen Blake, MD, FHRS represented the Heart Rhythm Society on the PCPI ACC/AHA Clinical Performance Measures for Adults with Chronic Heart Failure working group.
Validation of Quality Reporting
For the CY 2011 payment determination, CMS implemented a HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures using chart-abstracted data (however, the results of the validation will not affect the CY 2011 payment determination for any hospital). For the CY 2012 payment determination, CMS is proposing to validate data from 800 randomly selected hospitals. For each hospital, CMS is proposing to randomly select up to 12 cases per quarter. CMS is proposing to request the corresponding medical records for the cases, perform its own abstraction of the HOP QDRP chart-abstracted measures for the cases, and compares the results with the measures reported by the hospital. CMS is proposing to require hospitals to achieve a minimum 75 percent validation score based on this validation process to receive the full OPPS update in CY 2012.
As noted, the Society will continue its analysis of HOP QDRP proposed changes and submit comments on behalf of its membership and heart rhythm professionals. CMS will release the final rule later in the calendar year.
